The Impact of Acute Kidney Injury on Cervical Cancer Outcomes: A Retrospective Study in the Eastern Amazon

Abstract

Acute kidney injury (AKI) is a common clinical complication in cancer patients, especially in those with advanced gynecological neoplasms, such as cervical cancer, in which the progression often involves urological obstructions, sepsis, and drug toxicity. In this regard, the association between cervical cancer and AKI has resulted in increased morbidity and mortality and therapeutic complexity, requiring specific investigation into the clinical outcomes and prognostic factors involved. Given the scarcity of regional data on the subject, especially in the northern region of Brazil, it has become imperative to understand the profile of these patients and the variables that impact survival and hospital outcomes. Therefore, the aim of this research was to describe the clinical outcomes and analyze the clinical, nephrological, and therapeutic factors associated with the hospital evolution of patients with cervical cancer and AKI, admitted to the João de Barros Barreto University Hospital, in Belém do Pará, between 2022 and 2023. This cross-sectional, descriptive, and retrospective study was conducted through a review of medical records of patients simultaneously diagnosed with cervical cancer and AKI, admitted to HUJBB from January 2022 to July 2023. The study analysed sociodemographic, oncological, clinical, and laboratory variables, including tumour staging, KDIGO classification of AKI, and therapeutic interventions, number of hospitalizations, and hospital outcomes (discharge, death, survival). Thus, a sample composed mostly of brown women, of economically active age (mean of 53.5 years) and with low education was characterized; a high prevalence of oncological disease in stages III and IV (69.1%) and severe AKI (KDIGO III in 64.3%) was also observed. Regarding the outcomes, 42.9% of the patients died and 57.1% were discharged after the first hospitalization, with a mean survival of 457.9 days. As well as the presence of sepsis (26.2%), indication of palliative care (47.6%) and KDIGO III classification were significantly associated with death. In addition, patients with more than 10 hospitalizations had a longer mean survival time (653.8 days) compared to the others, and interventions such as hemodialysis and nephrostomy did not have a statistically significant impact on survival, but the use of a double J catheter showed a tendency for longer survival. Therefore, the study demonstrated that the clinical outcomes of patients with cervical cancer and AKI are more associated with the severity of renal injury, the presence of sepsis and the need for palliative care than with isolated tumor staging or specific urological interventions, highlighting the need for early clinical management, interdisciplinary monitoring and nephrological screening strategies in cancer patients, with a view to reducing mortality and prolonging survival in this vulnerable population.